Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

The Older Injured Worker

In the past, our older injured workers would more often than not seek retirement rather than attempt to return to work after injury. The older worker today does seem to have a clear plan in mind. They say that they wish to work, but do not mobilize to do so, and simply languish. If they are released by their primary doctor, they most often just ask for more opinions.

One of the consistencies with the older injured worker is the coexistence of other health problems, ranging from diabetes and hypertension to arthritis and cardiovascular disease. The older injured worker has to battle not only against the injury but against a body that increasingly betrays them as they age. This may not be a new concern, but it is something to keep in mind. My patients, over the age of fifty, often have comorbid (concurrent) unrelated health complaints that may need to be addressed by their personal physician but also interfere with injury-rehabilitation.

But you are correct: there are new complications and they are associated with the lack of ability to perform adequately in the job which they held prior to injury. This gives rise to fears of job loss. There may now be fear that the employer is no longer financially solvent and may have to close their doors in an economy that will not support them. Short of that, there is also downsizing: if you were trimming back on number of employees, admittedly, you would have to look for those who are simply going to be less productive than younger/healthier workers.

Also, consider that in the past, the individual had a retirement package/retirement savings and the combination of this and social security benefits may have been sufficient to create the option of retirement. The new reality is that these patients, for their financial survival, must return to work in some capacity, no longer have retirement funds and are looking at high potential for inflationary cost of living.

So, where does this leave us? It leaves us with elderly patients who feel that they have few-if-any options (helpless) and either attempt to work with multiple health complaints or try to survive with severe economic constraints. And it leaves us with elderly patients who have little potential (hopeless) to find new employment within the limitations imposed by the combination of their injury and increasing, age-related, health problems.

Until recent times, research told us to expect that the incidence of clinical depression would decrease after the mid 40s. And it taught us that most individuals in their 70s run a lesser risk of depression than younger people.

However, this all changes if the individual has injury-plus-financial problems with which they must cope on a daily basis. In such cases, we see depression again peak.

How do we approach this? On their own, the elderly injured worker may not be able to sort through all choices. I recommend that if the injured patient is above 55 years of age that he/she have the opportunity to discuss with someone their options in order to make an effective decision regarding return to productivity at this stage of life.”